Texas Crude Oil Tax Forms-10-165 Crude Oil Tax - Producer Special Lease Detail Supplement

1. 10-165
FFFF RESET FORM PRINT FORM
(Rev.12-08/2)
b.
48120
a. Page ______ of ______
SEE INSTRUCTIONS ON BACK.
c. Taxpayer number d. Filing period
Texas CRUDE OIL Tax
-- Producer SPECIAL Lease Detail Supplement --
f.
e. Taxpayer name
HP
1. Lease Name (as recorded with the Railroad Commission) 1. Lease Name (as recorded with the Railroad Commission)
2. County of Production 2. County of Production
3. Purchaser's Name 3. Purchaser's Name
4. County code 4. County code
Check Check
digit digit
5. Lease number 5. Lease number
YES NO YES NO
1 2 1 2
6. Is Item 5 a drilling permit number 6. Is Item 5 a drilling permit number
7. Exempt type (If applicable) 7. Exempt type (If applicable)
8. API number (If applicable) 8. API number (If applicable)
Baseline Incremental Baseline Incremental
9. Incremental exemption 9. Incremental exemption
1 2 1 2
(If applicable) (If applicable)
10. Purchaser's 10. Purchaser's
taxpayer number taxpayer number
YES NO YES NO
1 2 1 2
11. Lease operator indicator 11. Lease operator indicator
YES YES
1 1
12. Are you liable for tax? 12. Are you liable for tax?
13. API gravity 13. API gravity
14. Gross barrels 14. Gross barrels
(Enter whole barrels) (Enter whole barrels)
15. Governmental 15. Governmental
royalty barrels royalty barrels
(Enter whole barrels) (Enter whole barrels)
16. Taxable barrels 16. Taxable barrels
(Enter whole barrels) (Enter whole barrels)
$ $
17. Gross value 17. Gross value
(Dollars and cents) (Dollars and cents)
18. Governmental 18. Governmental
$ $
royalty value royalty value
(Dollars and cents) (Dollars and cents)
$ $
19. Trucking costs 19. Trucking costs
(Dollars and cents) (Dollars and cents)
$ $
20. Net taxable value 20. Net taxable value
(Dollars and cents) (Dollars and cents)

2. Form 10-165 (Back)(Rev.12-08/2)
INSTRUCTIONS FOR COMPLETING
TEXAS CRUDE OIL TAX PRODUCER SPECIAL LEASE DETAIL SUPPLEMENT
You have certain rights under Chapters 552 and 559, Government Code, to
review, request and correct information we have on file about you. Contact us
at the address or toll-free number listed on your report.
Items 1, 5, & 6 - For the lease name shown in Item 1, enter the identification number assigned by the Texas Railroad Commission (RRC) in Item 5.
Add a leading quot;0quot; (zero) to the 5-digit oil lease number assigned by the RRC. Also, enter the check digit in the box to the right. The Comptroller's
office can give you this number, or you may leave it blank. If the lease number has not been assigned by the RRC, use the drilling permit number in
Item 5. Mark Item 6 to denote if Item 5 is a drilling permit number.
Items 2 & 4 - In Item 2, enter the county of production. Enter the 3-digit county code for the county of production in Item 4. A list of county codes is
available in the Crude Oil Tax Guide and on the Comptroller's Web site at www.window.state.tx.us/taxinfo/taxforms/10-codes.html.
Items 3 & 10 - In Item 3, enter the name of your purchaser. In Item 10, enter the 11-digit taxpayer number, assigned by the Comptroller's office, for
the purchaser name listed in Item 3.
For Oil that was Lost, Stolen, or Unaccounted For - Enter your name and 11-digit taxpayer number.
For a One-Time Sale of Crude Oil - Enter the purchaser's name and 11-digit Texas taxpayer number.
Item 7 - Enter the Comptroller approved numeric legislative exempt type, if applicable.
02 = Enhanced Oil Recovery (EOR) Projects approved prior to January 1, 1994
03 = Two-Year Inactive Wells effective September 1, 1997
04 = Enhanced Oil Recovery (EOR) Projects approved January 1, 1994 through August 31, 1997
05 = Enhanced Oil Recovery (EOR) Projects approved after August 31, 1997
06 = Incremental Production Leases effective September 1, 1997
07 = Three-Year Inactive Wells effective September 1, 1993 (expired February 28, 2006)
08 = Co-Production Projects effective January 1, 1994
09 = Texas Experimental Research Recovery Activity (TERRA) Wells effective January 1, 1996
10 = Temporary Severance Tax Relief effective February 1, 1999 (expired July 31, 1999)
11 = Qualifying Low-Producing Leases effective September 1, 2005
12 = Reactivated Orphaned Wells effective January 1, 2006
13 = Enhanced Efficiency Equipment Wells effective September 1, 2005
14 = Enhanced Recovery Project Using Anthropogenic Carbon Dioxide effective September 1, 2007
Item 8 - Enter the American Petroleum Institute (API) number assigned to each well that qualifies for a well-level exemption. This must be
entered or the exemption will be disallowed. This includes exempt types 3, 7, 12 and 13.
Item 9 - For expanded EOR projects, mark the incremental exemption block to indicate that baseline production or incremental production is
being reported. NOTE: If you are reporting incremental production, baseline production must also be reported on a separate line.
Item 11 - If you are the physical operator of the lease, check quot;YES.quot; If you are an interest owner, check quot;NO.quot;
Item 13 - Enter your API gravity for the lease. This should be a numeric figure to the tenth (xx.x).
Item 14 - Enter the number of merchantable barrels sold, lost, stolen, or unaccounted for, or enter the gross barrels for a one-time sale. Round all
volumes up to the nearest whole number.
Item 15 - Enter the volume of oil not subject to tax because of a governmental exempt status, such as state royalty. See Rule 3.34 Exemption of
Certain Royalty Interests from Oil Occupation Taxes and Regulation Pipeline Taxes on our Web page. Round all volumes up to the
nearest whole number.
Item 16 - Enter the taxable volume (gross barrels - exempt barrels).
Item 17 - Enter the total value of the crude oil reported in Item 14. Enter dollars and cents.
Item 18 - Enter the value of oil not subject to tax because of a governmental exempt status, such as state royalty. See Rule 3.34 Exemption of
Certain Royalty Interests from Oil Occupation Taxes and Regulation Pipeline Taxes on our Web page. Enter dollars and cents.
Item 19 - Enter any physical trucking charges incurred by the producer. Enter dollars and cents.
Item 20 - Enter the value on which tax should be paid. For EOR (exempt types 2, 4 and 5), incremental production leases (exempt type 6) and
co-production projects (exempt type 8), enter one-half of (gross value minus exempt and trucking). For two-year inactive, three-year
inactive, TERRA and reactivated orphaned wells (exempt types 3, 7, 9 and 12), enter quot;0.quot; For low-producing oil leases (exempt type 11),
enter the taxable value based on the price of oil. See our web page to see the applicable tax credit. For enhanced efficiency equipment
(exempt type 13), enter quot;0quot; unless the tax credit of 10% of cost of equipment, not to exceed $1,000.00, has been reached. For Enhanced
Recovery Projects Using Anthropogenic Carbon Dioxide (exempt type 14), enter the taxable value based on the percentage of
anthropogenic carbon dioxide used in the project for the report period. Enter dollars and cents.